Goals for the Khabarovsk/KRAI Health Care System: Part 1 of 2
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Major development and directions in health care in Khabarovsk Area during the period of 1996-2005.
1. The necessity of establishing and accomplishing the major development and directions of the Health Care in the Khabarovsk area
The health care system of the Khabarovsk area is an important activity to provide citizens the right to life and health and thus it is one of the major priorities in the political, economic and social life of the area.
The current situation of health care in the area is characterized by an acute deficiency of resources for covering expenditures of medical facilities and conducting activities of preventing diseases. It brings a decline of potential opportunities in health care and in the productivity of labor resources.
Health conditions of the population in Khabarovsk area, as well as, all of Russia and the Far East is continuing to deteriorate.
In 1995 the mortality rate of the population was 12.0 out of 10,000 people,
which is 40.2 % over the mortality rate of the population in 1990. The main reasons of death are: cardiovascular diseases; trauma and poisoning; and oncological (cancer) diseases.
During the past five years, the mortalities due to cardiovascular diseases increased by 29%, and trauma and poisoning increased 1.6 times. In the structure of general mortality, mortality among the working age population increased by 44%. The decrease of average life expectation of the population in the Khabarovsk area went from 67.2 years in 1990 to 62.0 in 1995.
Infant mortality was also at a high rate, in 1995 the rate was 18.7 out of 1,000 new born. The main reasons for infant mortality in the area are: conditions that appeared during the prenatal period; congenital heart diseases, respiratory diseases, and infection diseases.
In comparison to 1990, the general morbidity of the population increased by 6%.
This results of unfavorable sanitation - epidemiological condition and growth ( in 1995) of such infectious diseases as diphtheria, tuberculosis, infection hepatitis, syphilis. From year to year the number of pathologies among pregnant women increases, which causes the birth of premature children and a high level of maternal death.
A high level of morbidity exists among children and adolescents.
A high level of morbidity results from nervous-psychiatric disorders, alcoholism, drug addiction. The health care system established in 1990 for the area with systematic financing was not enough to restrain the sharp process of deterioration of the population's health condition as related to the social-economic crises in Russia, as well as, this area.
For a period of decades a network of hospital facilities has been built up in the area without systematic planning. At the same time services of primary medical services: ambulatory-policlinic and ambulance medical services fell noticeably behind in their development.
Another result was inadequate delivery of preventive health care services and this constituted one of the major reasons for less than effective usage of scarce resources to meet the health care needs of the population. The network of medical facilities in the area doesn't permit the staged treatment-diagnose process, as it is accepted in developed countries of the world: Diagnose intensive therapy - final treatment - rehabilitation. In the system of health care in the area the first two stages don't work effectively enough and the last two just don't exist. There are no health care facilities for final treatment and rehabilitation, or for chronic patients, who need limited treatment but long term and constant care.
Inadequate resources for medical facilities and lack of modern diagnostic and therapeutic means make the patients' treatment period significantly longer. While there is a high level of physicians and mid-level medical personnel to the population in the area, the quality of their training in general doesn't correspond with the international level and this results in mistakes in diagnosis and treatment. There is no system of general practice physicians, functioning as constant observers of the patient at all stages of delivering a health care services.
Medical and scientific research need strengthening in the area. There is need for the medical scientific institutes to emphasize the themes of preventing disease and in improvement the treatment-diagnostic activities.
Complete (rooted) reconstruction is needed for the system of health management with the purpose of the activities being the improvement of the effectiveness of using the resources in medical technology. The health care in the area needs unified approaches to planning , based on deep systematic analysis of the health condition and the activities of the medical facilities.
The most vulnerable area in health care of this territory is the current condition of its financing. The essential principle of the priority to finance protected budgetary activities, deprives medical facilities of independence and doesn't allow them to renew main funds regularly to create economic conditions for the effective use of resources for medical technology. Implementation in the area of mandatory medical insurance enabled only partial fulfillment of the acute deficiency of financing of health care facilities and thus the quality of medical service hasn't been the focus of pricing for medical services.
Under current conditions the system of health care in the territory barley yields to changes and is not able to react dynamically enough to changing conditions.
This short analysis of the health condition in the territory raises a question about the necessity of the deep structural changes in the field of organization, function and management of the medical facilities.
The primary directions of health care development are defined according to the resolution made by the Head administration of the territory on October 30, 1995, #427 "About major directions of the structural reconstruction of the economy in the Khabarovsk area".
II. Goals , objectives, main principles and stages of the health care development in Khabarovsk area.
The goal of development of health care is to decrease the morbidity and mortality of the population in the area.
Objectives to fulfill the goal: - increasing the volume of activities on medical prophylactics; - rehabilitation of lost health within the shortest period of time, through delivering the population a qualified and generally available medical service.
The Main principles of the health care development are: prophylactic direction; unity of medical science and practice in health care; economic effectiveness and efficiency of the medical facilities function; active participation of health care personnel in the work of improving the quality of medical service; attract a wide range of the population in the activity of maintaining their health.
Stages of developing health care in the area:
stage of stabilization 1996-1997
stage of economic rising 1998-2000
stage of creative development 2001-2005
The practical realization of the main development directions in Khabarovsk will require working out a concrete program of activities, directed to solve the most important objectives to reduce the morbidity and mortality of the population.
The stage of stabilization 1996-1997
3.1. Forming the legislative base in health care:
3.1.1. to develop and pass the Laws in Khabarovsk area: about health care in Khabarovsk area; about medical and pharmaceutical activities in the Khabarovsk area; about medical insurance of citizens in Khabarovsk area.
3.2 Prevention of diseases
3.2.1. to develop the programs for the area: on vaccine prophylactics; on provision for sanitation-epidemiological health in the area; on preventing production line and road-transportation trauma; on preventing the expansion of AIDS; on prophylactics of diabetes; on preventing and campaigning against alcoholism and addiction; about forms self-protection in public health .
3.3 Provision of accessibility to the public for quality medical service.
3.3.1. to develop ambulatory - policlinic service :
to finish the construction of the policlinic # 3 in Khabarovsk, a holiday hotel of the Far East medical center; to finish the reconstruction of the policlinic in Amursk, the dental laboratory for the territorial dental policlinic, the territory cancer center, policlinic of Bikin region hospital; to initiate the system of family practice in Khabarovsk, Komsomolsk- na-Amure, and in the region named after Lazo; to organize in all policlinics one day hospitals and departments of home health care ; to reinforce the diagnostic base of policlinics (laboratory, endoscopy, ultrasound, X-ray); to organize regular visits of specialists into the territorial medical facilities of the regions of the territory for conducting prophylactic medical exams of thepopulation and for consulting with individuals with diagnosed disease.
3.3.2. to develop ambulance services:
to purchase ambulances centrally for 14 billion rubles; to equip stations for ambulance medical service with enough medicine, diagnostic and treatment equipment; to accomplish the transition to a sectional system of providing ambulance medical service in Khabarovsk and Komsomolsk-na-Amure.
3.3.3. development of hospital service:
to finish the construction of the hospital in Vyasma, Hurba village of Komsomolsk region, territorial prenatal center, maternity departments of the hospitals in Solnechniy and Ohotsk villages, the dining room at the hospital in Annenskiye vody, complex of transitions of the territorial hospital # 2; in Khabarovsk and Komsomolsk -na -Amure to restructure the large hospitals and polyclinics by organization of treatment-diagnostic stages: intensive therapy, final treatment, and medical rehabilitation. to continue to equip the diagnostic and intensive care departments and operating rooms with modern medical equipment,. to expand and equip the burn department of the territorial clinical hospital # 2 the with necessary equipment; to implement methods of aorta-coronary shunt and distance lithotripsy in the Far East medical center; to open a specialized department at the territorial center of psychiatric health for treating patients, suffering from addiction; to organize a prenatal center as part of the territorial center on protecting the health of mother and child,.
3.4. Improvement of health management.
3.4.1. to bring the structure of health management agencies of the territory to achieve common goals and solutions to the common objectives directed at reducing morbidity and mortality of the population;
3.4.2. to bring about an orderly system of management of health care institutions through distinguishing structures, managing the resource streams and the processes of providing medical services;
3.4.3. to develop and implement the common system of providing the information about the activities managing health care agencies and medical institutions.
3.5 Improvement in planning the health care.
3.5.1. to implement methods of planning health care, based on systematic analysis of the activity of the health care agencies and institutions, standards of the conditions to provide medical service and price of (tarriffs on) medical services;
3.5.2. With the purpose of reducing duplication of effort, wasting resources and disunity of activities while developing and implementing the program, we need to limit them by the following names: territorial (basic) and regional program of medical public service (annually); territorial (basic), city and regional programs to provide the public medicines and medical supplies (annually); territorial (basic), city and regional programs in the field of protecting the sanitation-epidemiological health (from 1 to 5 years);
territorial (basic), city and regional programs in the field of developing health care services ( from 3 to 5 years); territorial (basic), city and regional programs in the field of personnel policy in the domain of health care (from 3 to 5 years)
3.6 Financing health care .
3.6.1. to draw additional resources to finance the territorial health care: Khabarovsk regional department of retirement Fund of the Russian Federation to cover expenses, related to providing treatment services to pensioners such as medical rehabilitation in ambulatory-polyclinic conditions, to provide dentist services to make prosthetic appliance as a benefit; Khabarovsk regional department of the social insurance Fund of the Russian Federation for covering expenses, related : to providing medical services to children and adolescents, who improve their health in the city and out of city labor and vacation camps; to preparation and retraining of specialists in the field of rehabilitation medicine; to conduct post hospital stages of medical rehabilitation of the patients at the sanatoriums "Ussury", "Acursky", "Annenskiye vody", and holiday house "Friendship";
Khabarovsk region department of the employment Fund of the Russian Federation for covering expenses, related to conducting medical examinations to determine the suitability of individuals for employment or the admittance to study and the provision of some ambulatory medical rehabilitation for unemployed individuals;
Khabarovsk territorial Fund of providing social security to the population for covering the expenses of treating veterans in Khabarovsk branch "Microsurgery of the eye"; and technical maintenance of hearing aids for low income veterans of war or labor.
3.6.2. to drawing on personal funds of citizens by expanding billed medical services and services of non-medical character (selling medicine and items of hygiene and medical supply at the policlinics);
3.6.3 to develop marketing activity for medical institutions;
3.6.4. to establish territorial and municipal non-budget funds of healthcare.
3.7 Supplying medicine, reagents and medical equipment.
3.7.1. to implement a system of state regulation on prices of medicine by establishing a network of insured drug stores;
3.7.2. to prepare a program of increasing the production of medicine, medical supply and medical equipment by enterprises in the Khabarovsk territory;
3.7.3. to provide reserve stores of medicine in case of the need to provide
services as a result of disaster or catastrophe.
3.8 Innovative policy in health care.
3.8.1. to integrate the scientific activity in the field of health care at the territory by organizing a territorial committee on innovative policy in health care;
3.8.2. to work out a territorial program of implementing new medical technologies in practice of the health care facilities;
3.8.3. to deepen the cooperation of the territorial health care with the foreign clinics: Virginia Mason, University of Kentucky, Oregon University USA, prefect Aomory Japan.
3.9. Personnel policy in health care.
3.91. training personnel to accomplish the transition to advanced educational training of mid-level medical personnel; to implement a program of teaching the students of Khabarovsk medical university on questions of health care management; to continue the work on training family practice physicians; to establish a one year training school for specialists in the field of health care management (a day-time school and a correspondent department); to prepare a program of training and assigning medical personnel according to the demand of the territorial medical care institutions.
3.9.2. to increase the level of professional knowledge of health care professionals (post diploma education):
-to work out quality requirements for specialists in health care; to regularly conduct tests of the health care personnel to determine their suitability to their position in the health care institutions; to organize continuing education workshops for the medical personnel on questions of increasing the quality of medical services; to conduct annually territorial scientific practical conferences on problems of implementation of modern medical technology and improving the use of resources in health care; to start the work on identifying faculty for an institute with the function of improving the qualification of specialists in health care; to organize a training-methodical center at territorial policlinic # 1, for training and retraining specialists of ambulatory-policlinic services.
3.10. Improvement of effectiveness of managing resources in health care.
3.10.1. to organize a movement for efficient use of the main funds by the personnel of the health care facilities;
3.10.2. to provide for conformity of the professional level of health care personnel and the level of complexity and volume of their work;
3.10.3. to provide for the conformity of resource utilization standards and the standards for delivery of medical services;
3.10.4. to develop programs to implement resource saving technologies in health care facilities
3.11. Participation of the population in their personal health maintenance
3.11.1. to work out the programs through public and religious organizations to encourage the population to maintain their health;
3.11.2. to create public committees under the authority of state medical facilities to encourage the population to maintain their health;
3.11.3. to introduce a monthly column in pubic media "Be healthy",
3.11.4. to organize a public committee on protection of patient rights.
IV Stage of economic tide 1998-2000
4.1. Formation of a legislative base in health care
4.1.1. to develop and pass the Laws in Khabarovsk territory; about the state municipal and private systems of health care; about preventing diseases.
4.2. Prevention of diseases
4.2.1. to develop and approve territorial programs: on protection of the nature environment; on provision of a secure and healthy food supply for the population; on development of a sport culture and a sanitary tourism systems; on prevention teeth cavities
4.3. To increase the access to the population to quality medical service
4.3.1. to develop ambulatory-polyclinic service: to finish the construction of: the children's polyclinic in Lenin region in Komsomolsk -na-Amure, polyclinic in Troitsk Nanai region, polyclinic in the Lenin's precepts village of Sovgan region, polyclinic in Khor village of the region named Lazo; to accomplish the transition to the system of general practice physician in Khabarovsk, Komsomolsk -na -Amure, Amurskiy, Vanin, Songan regions.
4.3.2. to develop hospital service: to finish the construction:
in Khabarovsk of: maternity house, territorial center on prophylactics and treatment of AIDS, house for children, hospitals for water workers, lab facility in the territorial tuberculosis health center, holiday rest house for the cancer center.
in Komsomolsk -na-Amure: establish a private pay unit of the psychiatric hospital.
in regions of the territory: hospital in Lermontov village of Bikin region, hospital in Briakan village of the region named P.Osipenko, hospital in Gorin village of Solnechniy region, a 24 hour unit for the hospital "Annenskie Vody". to organize departments for treating patients during one day (same day surgery, etc.) in the big hospitals in Khabarovsk and Komsomolsk -na -Amure; to conduct re-equipment of regional hospital's X- ray equipment.
4.3.3. to develop ambulance medical services: to conduct re-equipment of posts and development of services by modern ambulances; to train personnel of ambulance medical service in intensive diagnostic and treatment methodologies; to organize a rescue service in some regions of Khabarovsk.
Goals for the Khabarovsk/KRAI Health Care System: Part 2
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Last Updated: January 9, 1996email: tsamuel@pop.uky.edu